Assessment of Local Health Department Utility of Syndromic Surveillance: Results of the 2015 Biosurveillance Needs Assessment Survey Sarah Chughtai, MPP; Katrina DeVore, MPH; Lilly Kan, MPH; Laura C. Streichert, PhD, MPH rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr
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yndromic surveillance (SyS) is a biosurveillance methodology that integrates new information technologies, electronic health record data, and principles of epidemiology and biostatistics. The data are collected from hospitals and public health departments and transmitted to public health agencies in near-real time (at least every 24 hours). The data reported are categorized as a “syndrome” on the basis of a collection of symptoms or other variables. The aggregate number of cases reported within syndromes reported is analyzed by trained practitioners (ie, epidemiologists) to prevent or mitigate potential outbreaks and assess the overall health of a community. SyS is an important tool that transcends the traditional use of detecting and monitoring bioterrorism events. The Centers for Medicare & Medicaid Services has included SyS reporting as a requirement for eligible hospitals for stage 2 Meaningful Use, which emphasizes the importance of the technology on a national level.1 This technology can be a useful tool when monitoring population health issues such as drugrelated hospitalizations, natural disaster–related illness/injury, and noncommunicable diseases/chronic disease. Public health activities and response can be further improved by the utility of SyS technology.
● Purpose of the 2015 Biosurveillance Needs Assessment In 2014, the National Association of County & City Health Officials (NACCHO) conducted a survey of 500 local health departments (LHDs) to further analyze the results of the NACCHO 2013 National Profile of Local Health Departments, which found that 62% of all LHDs surveyed had used some form of an electronic SyS system. This overwhelming response prompted staff at J Public Health Management Practice, 2016, 22(6 Supp), S69–S74 C 2016 Wolters Kluwer Health, Inc. All rights reserved. Copyright
the Centers for Disease Control and Prevention (CDC), NACCHO, and the International Society for Disease Surveillance (ISDS) to collaborate on the execution and assessment of the SyS capabilities of LHDs across the United States—Syndromic Surveillance Practice at Local Health Departments in the United States: Results from the 2015 NACCHO Biosurveillance Needs Assessment (2015 BNAS). The purpose of the study was to understand the nationwide management and use of electronic SyS practice among a sample of LHDs and to identify gaps and barriers to improve both individual and organizational capabilities in biosurveillance, as measured by SyS practice. The information from the survey is helpful in guiding the efforts of CDC, NACCHO, and ISDS, as well as other relevant partner organizations, in determining the public health surveillance needs of LHDs across the country. Potential activities include addressing specific technical assistance needs of novice, intermediate, and expert users of SyS, as well as providing resources in the form of webinars, online distance learning opportunities, and written resources.
Author Affiliations: National Association of County & City Health Officials, Washington, District of Columbia (Mss Chughtai and Kan); and International Society for Disease Surveillance, Brighton, Massachusetts (Ms DeVore and Dr Streichert). Financial support for the writing of the manuscript provided by the Centers for Disease Control and Prevention (CDC) through cooperative agreement (# 5U38OT000172-03) with NACCHO is gratefully acknowledged. The contents of this report are solely the responsibility of the authors and do not necessarily represent the official views of the CDC. The authors declare no conflicts of interest. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NCND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. Correspondence: Sarah Chughtai, MPP, National Association of County & City Health Officials, 1100 17th St NW, Seventh Floor, Washington, DC 20036 ([email protected]). DOI: 10.1097/PHH.0000000000000469
S69
S70 ❘ Journal of Public Health Management and Practice
● Methodology Study population and sampling The survey was distributed to a random sample of 500 LHDs from the NACCHO database. The sample criteria used to categorize the LHDs were SyS status and size of population served. The SyS status was determined by the LHD response to the 2013 National Profile of Local Health Departments. The criteria involved a random selection of LHDs—60% of individuals in the sample were from those who responded “yes,” 20% were from those who responded “no,” and another 20% were from nonrespondents to the previous NACCHO survey. The sample was stratified by the size of population within each group (50% of respondents) using any surveillance method include foodborne illness (95%), influenza-like illness (ILI) (91%), notifiable diseases (88%), gastrointestinal illness (80%), vector-borne disease (79%), animal bites (78%), and bioterrorism agents (68%). The least monitored (50% of respondents) categories monitored using SyS include only ILI (74%), gastrointestinal illness (67%), foodborne
S72 ❘ Journal of Public Health Management and Practice FIGURE 4 ● Percentage of Local Health Departments That
FIGURE 5 ● Percentage of Local Health Department
Monitor Health Issues With Any Surveillance Method Compared With Monitoring With Syndromic Surveillance (n = 109) qqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqq
Respondents Who Use SyS to Monitor Health Issues, by Level of SyS System Management qqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqq
Abbreviations: GI, gastrointestinal illness; ILI, influenza-like illness; NCD, noncommunicable disease.
illness (57%), and notifiable diseases (52%). The least monitored (
S
yndromic surveillance (SyS) is a biosurveillance methodology that integrates new information technologies, electronic health record data, and principles of epidemiology and biostatistics. The data are collected from hospitals and public health departments and transmitted to public health agencies in near-real time (at least every 24 hours). The data reported are categorized as a “syndrome” on the basis of a collection of symptoms or other variables. The aggregate number of cases reported within syndromes reported is analyzed by trained practitioners (ie, epidemiologists) to prevent or mitigate potential outbreaks and assess the overall health of a community. SyS is an important tool that transcends the traditional use of detecting and monitoring bioterrorism events. The Centers for Medicare & Medicaid Services has included SyS reporting as a requirement for eligible hospitals for stage 2 Meaningful Use, which emphasizes the importance of the technology on a national level.1 This technology can be a useful tool when monitoring population health issues such as drugrelated hospitalizations, natural disaster–related illness/injury, and noncommunicable diseases/chronic disease. Public health activities and response can be further improved by the utility of SyS technology.
● Purpose of the 2015 Biosurveillance Needs Assessment In 2014, the National Association of County & City Health Officials (NACCHO) conducted a survey of 500 local health departments (LHDs) to further analyze the results of the NACCHO 2013 National Profile of Local Health Departments, which found that 62% of all LHDs surveyed had used some form of an electronic SyS system. This overwhelming response prompted staff at J Public Health Management Practice, 2016, 22(6 Supp), S69–S74 C 2016 Wolters Kluwer Health, Inc. All rights reserved. Copyright
the Centers for Disease Control and Prevention (CDC), NACCHO, and the International Society for Disease Surveillance (ISDS) to collaborate on the execution and assessment of the SyS capabilities of LHDs across the United States—Syndromic Surveillance Practice at Local Health Departments in the United States: Results from the 2015 NACCHO Biosurveillance Needs Assessment (2015 BNAS). The purpose of the study was to understand the nationwide management and use of electronic SyS practice among a sample of LHDs and to identify gaps and barriers to improve both individual and organizational capabilities in biosurveillance, as measured by SyS practice. The information from the survey is helpful in guiding the efforts of CDC, NACCHO, and ISDS, as well as other relevant partner organizations, in determining the public health surveillance needs of LHDs across the country. Potential activities include addressing specific technical assistance needs of novice, intermediate, and expert users of SyS, as well as providing resources in the form of webinars, online distance learning opportunities, and written resources.
Author Affiliations: National Association of County & City Health Officials, Washington, District of Columbia (Mss Chughtai and Kan); and International Society for Disease Surveillance, Brighton, Massachusetts (Ms DeVore and Dr Streichert). Financial support for the writing of the manuscript provided by the Centers for Disease Control and Prevention (CDC) through cooperative agreement (# 5U38OT000172-03) with NACCHO is gratefully acknowledged. The contents of this report are solely the responsibility of the authors and do not necessarily represent the official views of the CDC. The authors declare no conflicts of interest. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NCND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. Correspondence: Sarah Chughtai, MPP, National Association of County & City Health Officials, 1100 17th St NW, Seventh Floor, Washington, DC 20036 ([email protected]). DOI: 10.1097/PHH.0000000000000469
S69
S70 ❘ Journal of Public Health Management and Practice
● Methodology Study population and sampling The survey was distributed to a random sample of 500 LHDs from the NACCHO database. The sample criteria used to categorize the LHDs were SyS status and size of population served. The SyS status was determined by the LHD response to the 2013 National Profile of Local Health Departments. The criteria involved a random selection of LHDs—60% of individuals in the sample were from those who responded “yes,” 20% were from those who responded “no,” and another 20% were from nonrespondents to the previous NACCHO survey. The sample was stratified by the size of population within each group (50% of respondents) using any surveillance method include foodborne illness (95%), influenza-like illness (ILI) (91%), notifiable diseases (88%), gastrointestinal illness (80%), vector-borne disease (79%), animal bites (78%), and bioterrorism agents (68%). The least monitored (50% of respondents) categories monitored using SyS include only ILI (74%), gastrointestinal illness (67%), foodborne
S72 ❘ Journal of Public Health Management and Practice FIGURE 4 ● Percentage of Local Health Departments That
FIGURE 5 ● Percentage of Local Health Department
Monitor Health Issues With Any Surveillance Method Compared With Monitoring With Syndromic Surveillance (n = 109) qqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqq
Respondents Who Use SyS to Monitor Health Issues, by Level of SyS System Management qqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqq
Abbreviations: GI, gastrointestinal illness; ILI, influenza-like illness; NCD, noncommunicable disease.
illness (57%), and notifiable diseases (52%). The least monitored (
